Diamond Catherine, Taylor Thomas H, Im Theresa, Anton-Culver Hoda
Department of Medicine, University of California-Irvine, 101 The City Drive, Orange, CA 92868, USA.
Leuk Lymphoma. 2006 Sep;47(9):1822-9. doi: 10.1080/10428190600658688.
We used the San Diego/Orange County cancer registry to identify 64 cases of systemic non-Hodgkin's lymphoma (NHL) with AIDS who received highly active antiretroviral therapy (HAART) at the time of NHL diagnosis or thereafter and 64 NHL controls without AIDS, matched on age, sex, race, time of NHL diagnosis (1994-1995 and 1996-1999), and hospital type (academic, large community, and small community). We compared cases and controls by chi-squared tests and Kaplan-Meier methods. Thirty-three percent of cases had high grade histology versus 11% of controls (p < 0.01); 69% had baseline hemoglobin <13 g/dL versus 35% controls (p < 0.001) and 21% had baseline neutrophils <2,000/mcl versus 4% of controls (p < 0.001). Overall median survival was 16 months for cases versus 99 months for controls (p < 0.01). Among 40 matched pairs of cases and controls who received chemotherapy, 32% of cases received reduced-dose chemotherapy versus 5% of controls (p < 0.01) and median survival was 33 months for cases and 99 months for controls (p < 0.44). Patients with AIDS-related NHL who received HAART had high grade histology and baseline cytopenia and received reduced-dose chemotherapy more often than patients without AIDS. However, AIDS patients who received HAART and chemotherapy had survival similar to NHL patients without AIDS, an improvement from the pre-HAART era. Appropriate hematologic support, through growth factors, transfusions, and avoidance of drugs with hematologic toxicity, might allow full dosing of chemotherapy, and perhaps would further improve outcomes among patients with AIDS and NHL.
我们利用圣地亚哥/奥兰治县癌症登记处，确定了64例系统性非霍奇金淋巴瘤（NHL）合并艾滋病患者，这些患者在NHL诊断时或之后接受了高效抗逆转录病毒治疗（HAART），并选取了64例无艾滋病的NHL对照，根据年龄、性别、种族、NHL诊断时间（1994 - 1995年和1996 - 1999年）以及医院类型（学术型、大型社区型和小型社区型）进行匹配。我们通过卡方检验和Kaplan - Meier方法对病例和对照进行比较。33%的病例组织学分级为高级别，而对照为11%（p < 0.01）；69%的病例基线血红蛋白<13 g/dL，对照为35%（p < 0.001），21%的病例基线中性粒细胞<2000/微升，对照为4%（p < 0.001）。病例的总体中位生存期为16个月，对照为99个月（p < 0.01）。在40对接受化疗的病例和对照中，32%的病例接受了减量化疗，对照为5%（p < 0.01），病例的中位生存期为33个月，对照为99个月（p < 0.44）。与无艾滋病的患者相比，合并艾滋病的NHL患者接受HAART后组织学分级为高级别且基线血细胞减少，接受减量化疗的频率更高。然而，接受HAART和化疗的艾滋病患者的生存期与无艾滋病的NHL患者相似，这与HAART时代之前相比有所改善。通过生长因子、输血以及避免使用具有血液学毒性的药物进行适当的血液学支持，可能会使化疗能够足量进行，并且或许会进一步改善艾滋病合并NHL患者的治疗结果。
